Modular Hook Plate Assembly

ABSTRACT

A hook plate assembly includes a bone plate extending along a longitudinal axis from a first end to a second end and including an upper surface facing away from a bone, a bone contacting surface, a plate hole extending therethrough from the upper surface to the bone contacting surface and a connection section arranged at the second end. The plate hole is sized and shaped to receive a bone fixation element therethrough in combination with a hook including a connecting portion configured to connect the hook to the connection section of the bone plate and a fastening element releasably coupling the hook to the bone plate.

PRIORITY CLAIM

The present application claims priority to U.S. Provisional ApplicationSer. No. 61/449,311 filed on Mar. 4, 2011 and entitled “Modular HookPlate Assembly,” the entire disclosure of which is incorporated hereinby reference.

FIELD OF THE INVENTION

The present invention generally relates to a surgical implant andmethods for treating a bone using the surgical implant. Moreparticularly, the present invention relates to a modular hook plateassembly and methods for stabilizing bony structures and/ordislocations. Exemplary embodiments of the present invention relate to akit comprising a bone plate and one or more hooks as well as a methodfor stabilizing clavicular fractures and/or dislocations of theacromioclavicular joint in either an open or minimally invasiveprocedure.

BACKGROUND

Antero-posterior stabilization of the acromioclavicular joint (AC-joint)is generally maintained via the ligamentum acromioclaviculare and partsof the trapezius and deltoideus muscle. Cranial stabilization isgenerally maintained via the conoid ligament and the trapezoid ligament(between the coracoid and the clavicle). A fall onto the shoulder with adirect force to the clavicle or on the outstretched arm is a commoncause for fractures of the bone or ruptures of the stabilizing softtissues. Simple fractures or minor AC luxations are treatedconservatively. However, more complex fractures such as, for example,Neer type II, Jäger and Breitner type II and acromio-clavicular jointdislocation types such as Tossy III and Rockwood III to V are treatedoperatively. The Neer and the Jäger and Breitner types involve a bonefracture while the Tossy and Rockwood types involve ruptures of theligaments without bone fractures.

Various types of fixation techniques and procedures exist for thetreatment of these dislocations, which may be divided into four basicprinciples:

1. Acromio-clavicular repairs (Fixation between the acromion and thedistal clavicle);

2. Coraco-clavicular repairs (Fixation between the coracoid and thedistal clavicle);

3. Distal clavicle excision; and

4. Dynamic muscle transfers.

Acromio-clavicular fixation may be performed using a clavicle hook plateand variations thereof such as, for example, the Balser plate and theWolter plate. Currently, the hook plate is used to treat claviclefractures associated with ruptures of the conoid ligament and trapezoidligament. The hook plate may be configured in either a left or rightversion and is commonly formed with three different hook depths. Theplate is used to join two bone fragments while the hook is placed underthe acromion and used to pull the clavicle to a normal positiongenerally maintained by the ligaments.

However, many patients treated with a hook plate show a phenomenoncalled “hook migration” in which the hook moves in a cranial directionduring healing. When the hook moves in a cranial direction, the hookpenetrates the subacrominal roof causing osteolysis.

Currently, the only solution to stop erosion and prevent osteolysis isto remove the osteosynthesis device early and hope that the bonefragments have consolidated. Thus, a major drawback of existing hookplates is the occurrence of osteolysis because of the hook being pressedagainst the AC-roof, which may lead to early removal of the plate evenwhen the fracture has not healed completely. A hook plate with a largerhook would result in subacrominal impingement.

As discussed above, a misplaced hook will begin to erode the acromion.In some situations, even a correctly placed hook may eventually resultin erosion. In these situations, the clavicle hook plate must be removedafter 3 months. After approximately three months the ruptured ligamentshave healed but the fracture may still be unstable. Thus, the surgeonmay have to make the difficult decision of either leaving the plateinside the patient and risking further damage to the acromion orremoving the plate early to prevent harm to the acromion while risking anew fracture.

SUMMARY OF THE INVENTION

It is an object of the present invention to provide a device and amethod for treatment of fractures at the lateral end of the clavicle,which permits correct restoration of the height of the clavicle relativeto the acromion while minimizing the risk of damaging the acromion.

The present invention relates to a hook plate assembly comprising: A) abone plate extending along a longitudinal axis from a first end to asecond end and including an upper surface, a bone contacting surface,one or more plate holes for receiving bone screws extending therethroughand a connection section terminally arranged towards the second end; andB) a hook connectable to the connection section. Further, the hook plateassembly comprises a fastening element which permits in situ attachmentand/or detachment of the hook from the bone plate.

One of the advantages of the hook plate according to the presentinvention is that the hook can be assembled and disassembled in situ.Thus, after three months, the hook may be removed from the patient tominimize the risk of osteolysis of the acromion while the bone plateremains fixed to the bone. The bone plate may then be removed afterapproximately one year, allowing the fracture to fully heal withoutrisking a further fracture of the clavicle.

In one exemplary embodiment of the hook plate assembly, the fasteningelement, when in a first position, permits the hook to be coupled to thebone plate. When the fastening element is in a second position, the hookis coupled to the bone plate such that the hook is rotatable relative tothe bone plate within a predetermined range of angulation. When thefastening element is in a third position, the hook is fixed in a desiredposition relative to the bone plate via, for example, a friction fit.The hook may be rotatable relative to the bone plate at an angle rangingfrom between, for example, 0° and 20° in an antero-posterior directionso that the surgeon may place the hook in a position in which the hookhas maximum contact with the bone surface. This distributes the loadexerted from the hook onto the acromion over a wider area to reduce therisk of occurrence of osteolysis.

In another exemplary embodiment of the hook plate assembly, the hookincludes a through hole in a part of the hook overlapping the plate.Thus, a bone screw may be inserted through the through hole and acorresponding aperture in the bone plate to reinforce the fixation ofthe hook to the bone plate and to the clavicle.

In a further exemplary embodiment of the hook plate assembly, athickness of the bone plate is a maximum of about 3.5 mm, but preferablya maximum of about 3.0 mm. For example, the thickness may be about 2.5mm. The hook plate may be placed on a surface of the clavicle, which isonly covered by a thin layer of soft tissue. A thin bone plate reducesdiscomfort and pain for the patient and prevents irritation of thesurrounding soft tissue.

In a further exemplary embodiment of the hook plate assembly, the hookmay have a raised section. The thickness of the hook may be a maximum ofabout 3.0 mm, but preferably about 2.5 mm. For example, the hook mayhave a thickness of about 2.0 mm. Preferably, the hook comprises araised section with a thickness of between 0.1 to 0.3 mm, where thethickness is in addition to the thickness of the hook.

In yet a further exemplary embodiment of the hook plate assembly, thehook is attachable to the bone plate within a portion of the bone platesuch that the height of the implant is not increased at the connectionsection where the hook is attached to the bone plate.

In another exemplary embodiment of the hook plate assembly, the hookincludes a plastic coating thereover. The plastic coating reducesfriction and optimizes the force distribution between the bone and theimplant to minimize the danger of osteolysis.

In another exemplary embodiment of the hook plate assembly, a depth T ofthe hook is a maximum of about 20 mm. For example, the depth T may be inthe range of about 18 mm to about 12 mm. Since the hook is removablyattachable to the bone plate, modular hooks may be provided, each hookwith a different hook depth such as, for example, about 12 mm, about 15mm and about 18 mm. Further, modular hooks with different hook bendingsmay be provided. The hook has an angle of bending X which may varybetween about 60° and about 120°.

In yet another exemplary embodiment of the hook plate assembly, a lengthL of the hook is a maximum of about 35 mm.

In yet another exemplary embodiment of the hook plate assembly, the hookis rotatable relative to the bone plate about an axis of rotationextending through the bone contacting surface, preferably orthogonal tothe bone contacting surface. A rotatable hook remedies the disadvantageof a non-articulated hook in which either the hook is not adjusted in aposition relative to the acromion where a damage of the acromion isminimized, or the hook is correctly positioned below the acromion butthe plate is not aligned on the bone. Therefore, the hook plate assemblypermits both minimization of the risk of damage to the acromion and thecorrect positioning of the bone plate.

In still another exemplary embodiment of the hook plate assembly, thebone plate has a longitudinal section extending towards the first end ofthe bone plate, wherein the bone plate is bent or angled when viewed ina front view. The bone plate may be bent or angled at an angle of about12° between the longitudinal section and the connection section.

In a further exemplary embodiment of the hook plate assembly, the hookis C-shaped or S-shaped.

In a further exemplary embodiment of the hook plate assembly, thefastening element is a screw including a head having a maximum height ofabout 1.5 mm to minimize the overall height of the hook plate. Forexample, the height of the head may be about 1.0 mm.

In a further exemplary embodiment of the hook plate assembly, theconnection section of the bone plate has a recess configured anddimensioned to receive a connecting portion of the hook. In a preferredembodiment the connecting portion protrudes from the upper surface.

In yet a further exemplary embodiment of the hook plate assembly, therecess is circularly curved and has a middle radius R. The recess may becircularly curved in a plane parallel to the bone contacting surface ofthe bone plate. The curved recess provides an articulated connectionbetween the bone plate and the hook without requiring a hinge pin sothat the hook plate assembly may have a smaller thickness.

In again a further exemplary embodiment of the hook plate assembly, theconnecting portion of the hook is correspondingly circularly curved withthe middle radius R in a plane parallel to the bone contacting surfaceof the bone plate.

In still a further exemplary embodiment of the hook plate assembly, thehook is rotatable relative to the bone plate up to about 20°. Due to therelatively small angular range of rotation, the articulation between thebone plate and the hook can be configured by arranging a portion of thehook curvedly sliding on the bone plate resulting in a minimum height ofthe articulation.

In another exemplary embodiment of the hook plate assembly, the hook hasa tip portion, wherein the hook is curved in a plane orthogonal to thebone contacting surface such that the tip portion protrudes from thesecond end of the bone plate parallel to or at an acute angle relativeto the longitudinal axis of the bone plate so that the hook may be slidunder the acromion.

In another exemplary embodiment of the hook plate assembly, the boneplate has an aperture penetrating through the connection section forreceiving a bone screw so that an additional bone screw may be insertedthrough the through hole in the hook and the aperture in the connectionsection of the bone plate to reinforce the connection between the hookand the plate as well as between the hook plate assembly and the bone.

In yet another exemplary embodiment of the hook plate assembly theaperture is located within the recess and is circularly curved with theradius R.

In yet another exemplary embodiment of the hook plate assembly, the hookis three-dimensionally curved.

In still another exemplary embodiment of the hook plate assembly, theone or more plate holes are elongated holes having a long axis extendingalong the longitudinal axis of the bone plate, and preferably having aninternal thread at one end of the long axis.

In yet another exemplary embodiment of the hook plate assembly—in a topview—the bone plate is S-shaped or C-shaped so that the bone platecorresponds to the shape of the bone (e.g., the clavicle which isS-shaped). If the bone plate is very short and has only one or two plateholes, the bone plate may be C-shaped.

According to a further aspect of the present invention, a kit comprisesa bone plate according to the invention and two or more hooks with adifferent hook shape. Some of the advantages of the kit according to theinvention are:

-   -   a hook with a suitable shape for the particular anatomy of the        patient can be selected;    -   a modular hook may be inserted into the body via a minimally        invasive surgery by first positioning the plate along the bone        and then attaching the hook to the plate in situ; and    -   the modular hook allows the implant assortment to be reduced.        Instead of having three hook sizes and four plate lengths which        sums up to 12 different plates, the modular system allows the        same variety with only seven implant parts. Smaller hook sizes,        which were carefully avoided thus far due to the large        assortment of different implants, are therefore also possible.

In accordance with another aspect, the present invention provides amethod for treating fractures of the lateral end of the clavicle using ahook plate assembly according to the invention. The method comprises thesteps of: a) forming a small incision near the lateral end of theclavicle; b) reducing the fracture and/or the dislocation; c) selectinga hook with an appropriate hook size; d) sliding the bone plate underthe skin along the clavicle; e) producing small incisions in the skin toadvance bone screws through the plate holes in the bone plate and intothe clavicle; f) advancing one or more bone screws through the plateholes in the bone plate and into the clavicle; d) connecting the hook tothe bone plate; g) turning the fastening element from the first positionto the second position to prevent disengagement of the hook; h)positioning the tip portion of the hook below the acromion by rotatingthe hook relative to the bone plate until an optimal fit with theacromion is achieved; i) moving the fastening element from the secondposition to the third position to fix the hook relative to the boneplate; and j) closing the incision. The fastening element ispre-operatively attached to the plate such that the fastening element ismovable between the first and second positions. Pre-operative attachmentof the fastening element prevents the small fastening element frombecoming lost during implantation thereof.

According to a further aspect of the present invention, there isprovided a method for treating fractures at the lateral end of theclavicle using a hook plate assembly according to the inventioncomprising the steps of: 1) forming a larger incision near the top ofthe lateral end of the clavicle; 2) reducing the fracture and/or thedislocation and selecting an appropriate hook size; 3) positioning thehook, which is connected to the bone plate with the fastening element inthe third position, under the acromion and pressing the bone plate ontothe clavicle; 4) advancing bone screws through the plate holes in thebone plate and into the clavicle; and 5) closing the incision.

In an exemplary embodiment, the method further comprises, before step5), the substeps of:

-   -   turning the fastening element to the second position;    -   rotating the hook to position the tip portion of the hook under        the acromion in an optimal position; and    -   moving the fastening element to the third position to fix the        hook relative to the bone plate.

In another exemplary embodiment, the method further comprises the stepof advancing an additional bone screw into the clavicle through thethrough hole in the hook and the aperture in the bone plate.

For example, and without limitation, the hook plate assembly accordingto invention may be used for treatment of fractures of the lateral endof the clavicle.

BRIEF DESCRIPTION OF THE DRAWINGS

Exemplary embodiments of the present invention will be described by wayof the following description and with reference to the accompanyingdrawings in which:

FIG. 1 illustrates a perspective view of a hook plate assembly accordingto an exemplary embodiment of the present invention;

FIG. 2 illustrates a magnified top view of a connection section of abone plate according to the hook plate assembly of FIG. 1;

FIG. 3 illustrates a side plan view of the hook plate assembly in thedirection of arrow A, as shown in FIG. 1;

FIGS. 4 a-4 c illustrate a top plan view of the connection section ofthe bone plate according to the hook plate assembly of FIG. 1, with thehook at different angles with respect to the bone plate;

FIGS. 5 a-5 c illustrate a top plan view of the connection section ofthe bone plate according to the hook plate assembly of FIG. 1, with thefastening element in different positions during implantation of thehook; and

FIGS. 6 a-6 c illustrate a top plan view of a hook assembly according toa further embodiment of the present invention, with a hook at differentangles with respect to a bone plate.

DETAILED DESCRIPTION

The present invention may be further understood with reference to thefollowing description and the appended drawings, wherein like elementsare referred to with the same reference numerals. The present inventionrelates to a device for treating fractures and, in particular, to aclavicle fracture. Exemplary embodiments of the present inventiondescribe a hook plate assembly comprising a bone plate sized and shapedto be positioned along a clavicle and a hook attachable to the boneplate.

FIGS. 1 to 5 illustrate an embodiment of the hook plate assembly 1comprising a bone plate 2 sized and shaped to be attached to a lateralportion of a clavicle via a bone fixation element such as a bone screw,and a hook 8 attachable to the bone plate 2 to be positioned under theacromion and a fastening element 9 to rigidly fix the hook 8 to the boneplate 2.

The bone plate 2 extends along a longitudinal axis 3 from a first end 4to a second end 5 and includes an upper surface 16 facing away from thebone, a bone contacting surface 14 and one or more plate holes 7extending therethrough from the upper surface 16 to the bone contactingsurface 14 for receiving bone screws therein. The bone plate 2 has alongitudinal section 20 extending towards the first end 4 of the boneplate 2 and a connection section 6 extending towards the second end 5.The connection section 6 has a width that is larger than a width of thelongitudinal section 20. Upon implantation of the bone plate 2, theconnection section 6 lies over a lateral end of the clavicle and thehook 8 is connectable thereto.

The bone plate 2 is sized and shaped to be positioned along theclavicle. For example, when viewed in a direction substantiallyperpendicular to one of the upper and bone contacting surfaces 16, 14,the longitudinal section 20 of the bone plate 2 may be substantiallyS-shaped—i.e., including two bends along a length thereof, in a planesubstantially parallel to one of the upper and bone contacting surfaces16, 14—so that its shape is adapted to that of the clavicle.

Alternatively, if the bone plate 2 is shorter so that the bone plate 2is sized to be positioned along only a portion of the clavicle, thelongitudinal section 20 may be substantially C-shaped—i.e., includingonly one bend along a length thereof, in a plane substantially parallelto one of the upper and bone contacting surfaces.

Further, when the bone plate 2, is viewed in a direction of arrow A asshown in FIG. 1, the longitudinal section 20 may be bent or angledrelative to the connection section at an angle of approximately 12° tofacilitate positioning of the bone plate 2 on the clavicle.

As shown in FIGS. 1 and 2, the connection section 6 of the bone plate 2includes a recess 17 along the upper surface 16, configured anddimensioned to receive a connecting portion 10 of the hook 8 therein sothat the connecting portion 10 protrudes slightly from the upper surface16 of the bone plate 2. The recess 17 may, for example, be circularlycurved with a middle radius R such that the concave side of the recess17 is directed towards the second end 5 of the bone plate 2. Thus, therecess 17 is circularly curved in a plane parallel to the bonecontacting surface 14 of the bone plate 2. Further, the circularlycurved recess 17 is open to the second end 5 at an opening 21 so that aremaining length of the hook 8 may extend past the second end 5 of thebone plate 2 in a lateral direction to engage the acromion.

The recess 17 may include an aperture 18 extending through the boneplate 2 along a portion thereof for receiving a bone screw. The aperture18 may be located within the recess 17 along a portion thereof such thatthe aperture may share the same radius R as the recess 17.

The longitudinal section 20 of the bone plate 2 may include a pluralityof plate holes 7 configured as elongated holes with their long axesextending along the longitudinal axis 3 of the bone plate 2. In oneexemplary embodiment, the bone plate 2 includes four plate holes 7. Itwill be understood by those of skill in the art, however, that the boneplate 2 may include any number of plate holes 7 so long as the plateholes 7 provide a desired level of fixation to the bone. In analternative embodiment, the plate holes 7 may be combination holesincluding an internal thread along one end thereof. The internal threadmay, for example, extend over more than 180°. The portion of the platehole 7 including the thread may be substantially cylindrical or conicalas those skilled in the art will understand.

The hook 8, as shown in FIGS. 1 and 3, includes a connecting portion 10and a tip portion 11 connected to one another via a transverse portion12. The connecting portion 10 is sized and shaped to be coupled to theconnection section 6 of the bone plate 2 by inserting the connectingportion 10 of the hook 8 into the recess 17. Thus, the connectingportion 10 of the hook 8 is correspondingly circularly curved and hasthe same middle radius R as the recess 17. The circularly curvedconnecting portion 10 defines a first plane of the hook 8. The tipportion 11 and the transverse portion 12 of the hook 8 lie in a secondplane that is orthogonal to the first plane defined by the circularlycurved connection portion 10. The bone contacting surface 14 may have alateral part 14 a and a medial part 14 b, the surfaces of which extendat an angle Y relative to each other. The angle Y can be any suitableangle chosen for anatomical reasons, for example, the angle can be 12°.The tip portion 11 may extend substantially parallel to the bonecontacting surface 14, in particular the lateral part 14 a, at theconnection section 6 of the bone plate 2 and forms an extension of thebone plate 2 in a longitudinal direction of the bone plate 2. Theconnecting portion 10 and the tip portion 11 extend in oppositedirections from the transverse portion 12 so that the hook 8 issubstantially S-shaped. Since each of the connecting portion 10, the tipportion 11 and the transverse portion 12 extends along a different axisthe hook 8 is thee-dimensionally curved. The hook 8 is used to pull theclavicle into a position that is normally maintained by the conoidligament and the trapezoid ligament.

The hook 8 may include a through hole 13 through a portion of theconnecting portion 10 of the hook 8 which overlaps the connectionsection 6 of the bone plate 2. The through hole 13 may be sized andshaped to receive a bone screw therethrough and into the aperture 18 inthe connection section 6 of the bone plate 2 to fix the hook 8 relativeto the bone plate 2 and the clavicle. The hook 8 may be treated with aplastic coating. Due to the circularly curved configuration of therecess 17 and the connecting portion 10 of the hook 8, the hook 8 isrotatable relative to the bone plate 2 about an axis of rotation. Asshown on FIG. 3, the axis of rotation extends through the lateral part14 a of the bone contacting surface 14 of the bone plate 2. The axis ofrotation may be substantially orthogonal to the lateral part 14 a of thebone contacting surface 14 of the bone plate 2. The hook 8 may rotaterelative to the bone plate 2 at an angle of up to about 20° about theaxis of rotation, in an anterior direction, as shown in FIGS. 4 a to 4c. The connecting portion 10 may also include a raised section 26extending about a periphery thereof for engagement by a portion of thefastening element 9, which fixes the hook 8 to the bone plate 2. Theraised section 26 is defined by a lateral wall 28.

The hook 8 has a depth T measured from an upper surface 22 (e.g., facingaway from the bone) of the connecting portion 10 to an upper surface 24(e.g., facing away from the bone) of the tip portion 11 of the hook 8which may range from about 18 mm to about 12 mm. In a preferredembodiment, the depth T will not exceed about 20 mm. Since the hook 8 isremovable from the bone plate 2, hooks 8 with different depths T, e.g.of 12 mm, 15 mm and 18 mm may be included so that the user (e.g.,surgeon) may select the hook 8 having a desired depth T, particularlysuited for the patient. The depth T may be chosen by the user to, forexample, avoid soft tissue irritation. Furthermore, the user may selecta hook 9 having a desired angle X between the upper surface 22 of thetip portion 11 and the transverse portion 12. The angle X of hooks 8 mayvary from between about 60° and about 120°. Similarly, hooks 8 having arange of different lengths L may be included so that the user may selecta hook 8 having the desired length L. Any suitable length L may beprovided and may be chosen by the user according to a patient's anatomy.For example, the length chosen may be according to the size of apatient, the shape of the clavicle or acromion, etc., and so that thehook plate assembly 1 does not irritate soft tissue or interfere with apatient's proximal humerus when in position. The length L may range frombetween about 20 mm to 50 mm.

The fastening element 9 may be screwed into the connection section 6 ofthe bone plate 2 and comprises a head 15 including a nose 19 extendingtransversely from a longitudinal axis of the fastening element 9. Thefastening element 9 may be pre-assembled with the bone plate 2 toprevent loss of the fastening element 9 during the surgery. As shown inFIGS. 5 a to 5 c the fastening element 9 may be movable between threepositions. In the first position shown in FIG. 5 a, the fasteningelement 9 is positioned so that the nose 19 does not extend over therecess 17, permitting an in situ attachment and/or detachment of thehook 8 from the bone plate 2. Once the hook 8 is coupled to the boneplate 2 by inserting the connecting portion 10 of the hook 8 into therecess 17, the fastening element 9 may be moved to the second position,as shown in FIG. 5 b, in which the fastening element is rotated aboutthe longitudinal axis thereof such that the nose 19 is slid over theraised section 26 along the upper surface of the connecting portion 10of the hook 8. The nose 19 abuts the raised section 26 to hold the hook8 in the recess 17 and to prevent the hook 8 from slipping out of therecess 17. in this second position, the nose 19 extends over a portionof the raised section 26 and applies a small friction force in order tohold the hook 8 in the recess 17. Thus, when the fastening element 9 isin the second position, the hook 8 is rotatable relative to the boneplate 2, as described above. Once the hook 8 has been rotated to adesired position relative to the bone plate 2 and is correctlypositioned under the acromion, the fastening element 9 may be rotatedabout the longitudinal axis thereof and moved to a third position, asshown in FIG. 5 c. This rotation causes more of the nose 19 to beengaged with the raised section 26 thereby increasing the friction forceto hold the hook 8 in a desired position and prevent further rotation ofthe hook 8 relative to the bone plate 2. Also, due to the screw holdingthe fastening element 9 to the bone plate 2, the rotation from thesecond position to the third position may also causes the nose 19 tomove closer in a perpendicular direction to the upper surface 16 of thebone plate 2. This slight movement causes the nose 19 to apply morepressure on the raised section 26 to thereby increase the friction forcebetween the hook 8 and the recess 17.

The hook plate assembly 1 may be configured in either a left side or aright side configuration. The curvature of the longitudinal section 20of the bone plate 2, the recess 17 and the hook 8 may be respectivelyadapted such that the hook plate assembly I may be used on the patient'sleft or right side.

A thickness of the bone plate 2 may be about 3.5 mm with a thickness of0.5 mm in the recess 17, while the thickness of the hook 8 may be about3.0 mm with the raised section 26 having a thickness of 0.1 mm to 0.3mm. Alternatively, the thickness of the bone plate 2 may be about 3.0 mmwith a thickness of 0.5 mm in the recess 17, and the thickness of thehook 8 may be about 2.5 mm with the raised section 26 having a thicknessof 0.1 mm to 0.3 mm. It will be understood by those of skill in the art,however, that the bone plate 2 and the hook 8 may have any of a varietyof thicknesses so long as the thickness of the bone plate 2 and of thehook 8 are selected such that the connecting portion 10 of the hook 8slightly protrudes from the upper surface 16 of the bone plate 2 in theraised section 26.

As described above, the hook assembly 1 may be used to treat a fractureof a clavicle, proximate a lateral end thereof. The method for treatmentof fractures of the lateral end of the clavicle may be performed using aminimally invasive procedure. During such a procedure a small incisionnear the lateral end of the clavicle is performed and the fractureand/or the dislocation are reduced. The user (e.g., surgeon) may selecta bone plate 2 having a desired length and a hook 8 having anappropriate hook size (e.g., length, angulation, depth). The bone plate2 may be slid through the incision under the skin along the clavicle.Once the bone plate 2 has been positioned as desired, small incisionsmay be formed in the skin to advance bone screws through the plate holes7 in the bone plate 2 and into the clavicle. The screws are thenadvanced through the plate holes 7 and into the clavicle to fix theplate 2 thereto. As described above, the fastening element 9 is attachedto the bone plate 2 prior to implantation thereof. The fastening element9 is moved to the first position so that the hook 8 may then be coupledto the bone plate 2 by inserting the connecting portion 10 of the hook 8into the recess 17 of the connecting portion 6 of the bone plate 2. Thefastening element 9 is turned from the first position to the secondposition to prevent disengagement of the hook 8 from the bone plate 2while the tip portion 11 of the hook 8 is positioned below the acromionby rotating the hook 8 relative to the bone plate 2. The hook 8 isrotated until an optimal fit with the acromion is achieved. Once thehook 8 has been positioned as desired, the fastening element 9 is movedfrom the second position to the third position to fix the hook 8relative to the bone plate 2. Finally, the incision is closed.

Before the incision is closed, if necessary, an additional bone screwmay be advanced into the clavicle through the through hole 13 in thehook 8 and the aperture 18 in the bone plate 2 to provide furtherfixation of the hook 8 relative to the bone plate 2 and the clavicle.

According to an alternative exemplary method, the hook assembly 1 may beused in the standard way in which a user performs open surgery toachieve a desired open reduction and internal fixation. In thealternative exemplary method, the hook 8 may be attached to the boneplate 2 prior to the implantation thereof so that the clavicle fracturemay be treated by forming a large incision near the lateral end of theclavicle. A desired bone plate 2 and hook 8 are selected and assembledby moving the fastening element 9 from the first position to the secondposition, as described above. The hook assembly 1 is then positionedalong the clavicle once the fracture and/or the dislocation has beenreduced. The hook 8 is rotated and positioned under the acromion and thebone plate 2 is pressed onto the clavicle. The fastening element 9 maybe moved to the third position to fix the hook 8 relative to the boneplate 2. Bone screws are then advanced through the plate holes 7 in thebone plate 2 and into the clavicle. The incision may then be closed.

If it is determined that the position of the hook 8 is not appropriate,prior to closing the incision, the fastening element 9 may be moved tothe second position after the bone screws have been advanced into theclavicle. The tip portion 11 of the hook 8 may then be positioned underthe acromion in the optimal position and the fastening element 9 may besubsequently moved to the third position to fix the hook 8 relative tothe bone plate 2. If necessary, an additional bone screw may be advancedinto the clavicle through the through hole 13 in the hook 8 and throughthe aperture 18 in the bone plate 2.

As shown in FIGS. 6 a-6 c, a hook plate assembly 1′ according to afurther embodiment may be substantially similar to the hook plateassembly 1, comprising a bone plate 2′ sized and shaped to be positionedover a lateral portion of a clavicle, a hook 8′ couplable to the boneplate 2′ to be positioned under the acromion and a fastening element 9′to rigidly fix the book 8′ to the bone plate 2′. While the hook 8 isrotatable relative to the bone plate 2 in an anterior direction up toabout 20° about an axis of rotation, the hook 8′ is rotatable relativeto the bone plate 2′ in both an anterior and a posterior direction up toabout ±20°. The hook assembly 1′ may be used to treat clavicularfractures in a manner substantially similar to the method describedabove in regard to the hook assembly 1. Once the bone plate 2′ has beenpositioned over the lateral end of the clavicle, however, the fasteningelement 9′ is moved to the second position such that the hook 8′ may berotated and positioned under the acromion. The bone fastening element 9′may then be moved to the third position to fix the hook 8′ relative tothe bone plate 2′. Bone screws may then be inserted through holes 7′extending through the bone plate 2′ to fix the hook assembly 1′ to thebone.

Although the invention and its advantages have been described in detail,it should be understood that various changes, substitutions, andalterations can be made herein without departing from the spirit andscope of the invention as defined by the appended claims. Moreover, thescope of the present application is not intended to be limited to theparticular embodiments of the process, machine, manufacture, compositionof matter, means, methods and steps described in the specification. Asone of ordinary skill in the art will readily appreciate from thedisclosure of the present invention, processes, machines, manufacture,composition of matter, means, methods, or steps, presently existing orlater to be developed that perform substantially the same function orachieve substantially the same result as the corresponding embodimentsdescribed herein may be utilized according to the present invention.

It will be appreciated by those skilled in the art that variousmodifications and alterations of the invention can be made withoutdeparting from the broad scope of the appended claims. Some of thesehave been discussed above and others will be apparent to those skilledin the art.

1-30. (canceled)
 31. A method for treating a clavicle, comprising:positioning a bone plate over a desired portion of the clavicle, thebone plate extending along a longitudinal axis from a first end to asecond end and including an upper surface facing away from a bone, abone contacting surface, a plate hole extending therethrough from theupper surface to the bone contacting surface and a connection sectionarranged at the second end; advancing at least one bone fixation elementthrough the plate hole into the clavicle; connecting a connectingportion of a hook to the connection section of the bone plate via afastening element; moving the fastening element from a first position toa second position to prevent disengagement of the hook from the plate;rotating the hook relative to a longitudinal axis of the bone plate toposition a tip of the hook below an acromion of the clavicle; and movingthe fastening element from the second position to a third position tofix the hook at a desired angle relative to the bone plate.
 32. Themethod according to claim 31, further comprising the step of: advancingan additional bone fixation element into the clavicle through a hole inthe hook and an aperture in the bone plate to provide further fixationof the hook relative to the bone plate and the clavicle.
 33. The methodaccording to claim 31, wherein the hook is rotatable about an axis ofrotation relative to the bone plate in an anterior direction up to about20 degrees.
 34. The method according to claim 33, wherein the hook isrotatable relative to the bone plate in both an anterior and a posteriordirection from about −20 degrees to about 20 degrees about the axis ofrotation.
 35. A method for treating a clavicle, comprising: reducing oneof a fracture and the dislocation of the clavicle; positioning a boneplate on a desired portion of the clavicle; coupling a hook to the boneplate via a fastening element and positioning the hook under an acromionof the clavicle, the bone plate extending along a longitudinal axis froma first end to a second end and including an upper surface facing awayfrom a bone, a bone contacting surface, the bone plate further includinga plate hole extending therethrough from the upper surface to the bonecontacting surface and including a connection section at the second end;and advancing a bone fixation element through the plate hole and intothe clavicle.
 36. The method according to claim 35, further comprising:moving the fastening element from a first position to a second positionto prevent the hook from being decoupled from the bone plate whilepermitting the hook to rotate relative to the longitudinal axis of thebone plate; rotating the hook to position a tip of the hook to a firstposition under the acromion; and moving the fastening element from thesecond position to a third position to fix the hook at a desired anglerelative to the bone plate.
 37. The method according to claim 36,further comprising the step of: advancing an additional bone fixationelement into the clavicle through a through hole in the hook and anaperture in the bone plate.
 38. The method according to claim 37,wherein the bone plate includes a plurality of holes extendingtherethrough, the holes being sized and shaped to accommodate bonefixation elements to extend therethrough into the clavice.
 39. Themethod according to claim 36, wherein the fastening element is movedfrom the first position to the second position before the bone plate hasbeen positioned over the desired portion of the clavicle.
 40. The methodaccording to claim 39, wherein the hook is rotatable relative to thebone plate in an anterior direction up to 20 degrees about an axis ofrotation.
 41. The method according to claim 36, wherein the fasteningelement is moved from the first position to the second position afterthe bone plate has been positioned over the desired portion of theclavicle.
 42. The method according to claim 41, wherein the hook isrotatable relative to the bone plate in both an anterior and a posteriordirection from −20 degrees to 20 degrees about an axis of rotation. 43.The method according to claim 36, further comprising: moving thefastening element from the third position to the second position afterthe bone fixation element has been advanced into the clavicle;repositioning the tip of the hook to a second position under theacromion; moving the fastening element from the second position to thethird position to fix the hook relative to the bone plate.